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Korean Circ J. 2003 Oct;33(10):909-917. Korean. Original Article.
Kim JH , Shin MS , Hwang KH , Han SH , Koh KK , Ahn TH , Choi IS , Park CH , Park KY , Shin EK .
Department of Nuclear Medicine, Gachon Medical School, Gil Heart Center, Incheon, Korea.
Department of Internal Medicine, Gachon Medical School, Gil Heart Center, Incheon, Korea.
Department of Thoracic Surgery, Gachon Medical School, Gil Heart Center, Incheon, Korea.

BACKGROUND AND OBJECTIVES: It is known that sympathetic reinnervation, following a heart transplantation, increases with time. 123I metaiodobenzylguanidine (123I-MIBG) is taken up by myocardial sympathetic neurons in a manner similar to norepinephrine (NE), and is used as an imaging agent. The purpose of this study was to evaluate cardiac sympathetic reinnervation, following an orthotopic heart transplantation, using 123I-MIBG scintigraphy. SUBJECTS AND METHODS: Twenty four 123I-MIBG images of the chest were taken in 15 patients (10 males, 5 females, mean age: 35+/-13 years), 1 to 48 (mean 10.8+/-11.9) months after a transplantation. Two healthy adults were studied as normal controls. The 123I-MIBG images were acquired at 15 minutes, and 4 and 24 hours, after an intravenous injection of 185 MBq 123I-MIBG. To quantitate the degree of myocardial uptake of the MIBG, the heart to mediastinal ratio (HMR) was measured. In nine patients, the 123I-MIBG scintigraphy was repeated one year later. RESULTS: The HMRs of the 4 and 24 hour images (1.26+/-0.23, 1.06+/-0.10, respectively) were lower than those of the 15 minute images (1.48+/-0.28). Twelve subjects, 1 to 12 months after the transplantation, showed no visible myocardial activities, but 12 subjects, 13 to 48 (28.6+/-12.8) months after the transplantation, showed visible myocardial 123I-MIBG uptakes (HMR: 1.65+/-0.21). The HMRs were high in normal controls (mean 2.84). One-year follow up scintigraphy showed increased HMRs compared with those taken immediately postoperatively (1.40+/-0.31 to 1.61+/-0.16, p<0.05). CONCLUSION: Partial sympathetic late reinnervation can occur one year after a transplantation.

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